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|THE DOCTOR'S OPINION |
WE OF Alcoholics Anonymous believe that the
reader will be interested in the medical esti-
mate of the plan of recovery described in this book.
Convincing testimony must surely come from medical
men who have had experience with the sufferings of
our members and have witnessed our return to health.
A well-known doctor, chief physician at a nationally
prominent hospital specializing in alcoholic and drug
addiction, gave Alcoholics Anonymous this letter:
To Whom It May Concern:
I have specialized in the treatment of alcoholism
for many years.
In late 1934 I attended a patient who, though he had
been a competent businessman of good earning ca-
pacity, was an alcoholic of a type I had come to regard
In the course of his third treatment he acquired cer-
tain ideas concerning a possible means of recovery. As
part of his rehabilitation he commenced to present his
conceptions to other alcoholics, impressing upon them
that they must do likewise with still others. This has
become the basis of a rapidly growing fellowship of
these men and their families. This man and over one
hundred others appear to have recovered.
I personally know scores of cases who were of the
type with whom other methods had failed completely.
These facts appear to be of extreme medical impor-
tance; because of the extraordinary possibilities of rapid
|xxiv THE DOCTOR'S OPINION |
growth inherent in this group they may mark a new
epoch in the annals of alcoholism. These men may
well have a remedy for thousands of such situations.
You may rely absolutely on anything they say about
themselves. Very truly yours,
William D. Silkworth, M.D. The physician who, at our request, gave us this let-
ter, has been kind enough to enlarge upon his views in
another statement which follows. In this statement he
confirms what we who have suffered alcoholic torture
must believe—that the body of the alcoholic is quite as
abnormal as his mind. It did not satisfy us to be told
that we could not control our drinking just because we
were maladjusted to life, that we were in full flight
from reality, or were outright mental defectives. These
things were true to some extent, in fact, to a consider-
able extent with some of us. But we are sure that our
bodies were sickened as well. In our belief, any pic-
ture of the alcoholic which leaves out this physical
factor is incomplete.
The doctor's theory that we have an allergy to al-
cohol interests us. As laymen, our opinion as to its
soundness may, of course, mean little. But as ex-
problem drinkers, we can say that his explanation
makes good sense. It explains many things for which
we cannot otherwise account.
Though we work out our solution on the spiritual as
well as an altruistic plane, we favor hospitalization for
the alcoholic who is very jittery or befogged. More
often than not, it is imperative that a man's brain be
cleared before he is approached, as he has then a bet-
THE DOCTOR'S OPINION xxv ter chance of understanding and accepting what we
have to offer.
The doctor writes:
The subject presented in this book seems to me to be of
paramount importance to those afflicted with alcoholic
I say this after many years' experience as Medical
Director of one of the oldest hospitals in the country treat-
ing alcoholic and drug addiction.
There was, therefore, a sense of real satisfaction when I
was asked to contribute a few words on a subject which is
covered in such mastery detail in these pages.
We doctors have realized for a long time that some form
of moral psychology was of urgent importance to alcoholics,
but its application presented difficulties beyond our concep-
tion. What with our ultra-modern standards, our scientific
approach to everything, we are perhaps not well equipped
to apply the powers of good that lie outside our synthetic
Many years ago one of the leading contributors to this
book came under our care in this hospital and while here
he acquired some ideas which he put into practical applica-
tion at once.
Later, he requested the privilege of being allowed to tell
his story to other patients here and with some misgiving,
we consented. The cases we have followed through have
been most interesting; in fact, many of them are amazing.
The unselfishness of these men as we have come to know
them, the entire absence of profit motive, and their com-
munity spirit, is indeed inspiring to one who has labored
long and wearily in this alcoholic field. They believe in
themselves, and still more in the Power which pulls chronic
alcoholics back from the gate of death.
Of course an alcoholic ought to be freed from his physical
|xxvi THE DOCTOR'S OPINION |
craving for liquor, and this often requires a definite hospital
procedure, before psychological measures can be of maxi-
We believe, and so suggested a few years ago, that the
action of alcohol on these chronic alcoholics is a manifesta-
tion of an allergy; that the phenomenon of craving is limited
to this class and never occurs in the average temperate
drinker. These allergic types can never safely use alcohol
in any form at all; and once having formed the habit and
found they cannot break it, once having lost their self-
confidence, their reliance upon things human, their prob-
lems pile up on them and become astonishingly difficult
Frothy emotional appeal seldom suffices. The message
which can interest and hold these alcoholic people must
have depth and weight. In nearly all cases, their ideals
must be grounded in a power greater than themselves, if
they are to re-create their lives.
If any feel that as psychiatrists directing a hospital for
alcoholics we appear somewhat sentimental, let them stand
with us a while on the firing line, see the tragedies, the
despairing wives, the little children; let the solving of these
problems become a part of their daily work, and even of
their sleeping moments, and the most cynical will not
wonder that we have accepted and encouraged this move-
ment. We feel, after many years of experience, that we
have found nothing which has contributed more to the
rehabilitation of these men than the altruistic movement
now growing up among them.
Men and women drink essentially because they like the
effect produced by alcohol. The sensation is so elusive that,
while they admit it is injurious, they cannot after a time
differentiate the truth from the false. To them, their alco-
holic life seems the only normal one. They are restless,
irritable and discontented, unless they can again experience
THE DOCTOR'S OPINION xxvii the sense of ease and comfort which comes at once by tak-
ing a few drinks—drinks which they see others taking with
impunity. After they have succumbed to the desire again,
as so many do, and the phenomenon of craving develops,
they pass through the well-known stages of a spree, emerg-
ing remorseful, with a firm resolution not to drink again.
This is repeated over and over, and unless this person can
experience an entire psychic change there is very little hope
of his recovery.
On the other hand—and strange as this may seem to those
who do not understand—once a psychic change has occurred,
the very same person who seemed doomed, who had so
many problems he despaired of ever solving them, suddenly
finds himself easily able to control his desire for alcohol,
the only effort necessary being that required to follow a
few simple rules.
Men have cried out to me in sincere and despairing ap-
peal: "Doctor, I cannot go on like this! I have everything
to live for! I must stop, but I cannot! You must help me!"
Faced with this problem, if a doctor is honest with him-
self, he must sometimes feel his own inadequacy. Although
he gives all that is in him, it often is not enough. One feels
that something more than human power is needed to pro-
duce the essential psychic change. Though the aggregate
of recoveries resulting from psychiatric effort is consider-
able, we physicians must admit we have made little
impression upon the problem as a whole. Many types do
not respond to the ordinary psychological approach.
I do not hold with those who believe that alcoholism is
entirely a problem of mental control. I have had many
men who had, for example, worked a period of months on
some problem or business deal which was to be settled on
a certain date, favorably to them. They took a drink a day
or so prior to the date, and then the phenomenon of craving
at once became paramount to all other interests so that the
|xxviii THE DOCTOR'S OPINION |
important appointment was not met. These men were not
drinking to escape; they were drinking to overcome a crav-
ing beyond their mental control.
There are many situations which arise out of the phenom-
enon of craving which causes men to make the supreme
sacrifice rather than continue to fight.
The classification of alcoholics seems most difficult, and
in much detail is outside the scope of this book. There are,
of course, the psychopaths who are emotionally unstable.
We are all familiar with this type. They are always "going
on the wagon for keeps." They are over-remorseful and
make many resolutions, but never a decision.
There is the type of man who is unwilling to admit that
he cannot take a drink. He plans various ways of drinking.
He changes his brand or his environment. There is the type
who always believes that after being entirely free from
alcohol for a period of time he can take a drink without
danger. There is the manic-depressive type, who is, per-
haps, the least understood by his friends, and about whom
a whole chapter could be written.
Then there are types entirely normal in every respect
except in the effect alcohol has upon them. They are often
able, intelligent, friendly people.
All these, and many others, have one symptom in com-
mon; they cannot start drinking without developing the
phenomenon of craving. This phenomenon, as we have
suggested, may be the manifestation of an allergy which
differentiates these people, and sets them apart as a distinct
entity. It has never been, by any treatment with which we
are familiar, permanently eradicated. The only relief we
have to suggest is entire abstinence.
This immediately precipitates us into a seething caldron
of debate. Much has been written pro and con, but among
physicians, the general opinion seems to be that most
chronic alcoholics are doomed.
THE DOCTOR'S OPINION xxix What is the solution? Perhaps I can best answer this by
relating one of my experiences.
About one year prior to this experience a man was
brought in to be treated for chronic alcoholism. He had
but partially recovered from a gastric hemorrhage and
seemed to be a case of pathological mental deterioration.
He had lost everything worthwhile in life and was only
living, one might say, to drink. He frankly admitted and
believed that for him there was no hope. Following the
elimination of alcohol, there was found to be no permanent
brain injury. He accepted the plan outlined in this book.
One year later he called to see me, and I experienced a
very strange sensation. I knew the man by name, and
partly recognized his features, but there all resemblance
ended. From a trembling, despairing, nervous wreck, had
emerged a man brimming over with self-reliance and con-
tentment. I talked with him for some time, but was not
able to bring myself to feel that I had known him before.
To me he was a stranger, and so he left me. A long time
has passed with no return to alcohol.
When I need a mental uplift, I often think of another
case brought in by a physician prominent in New York.
The patient had made his own diagnosis, and deciding his
situation hopeless, had hidden in a deserted barn deter-
mined to die. He was rescued by a searching party, and,
in desperate condition, brought to me. Following his
physical rehabilitation, he had a talk with me in which he
frankly stated he thought the treatment a waste of effort,
unless I could assure him, which no one ever had, that in
the future he would have the "will power" to resist the
impulse to drink.
His alcoholic problem was so complex, and his depres-
sion so great, that we felt his only hope would be through
what we then called "moral psychology," and we doubted
if even that would have any effect.
|xxx THE DOCTOR'S OPINION |
However, he did become "sold" on the ideas contained
in this book. He has not had a drink for a great many years.
I see him now and then and he is as fine a specimen of
manhood as one could wish to meet.
I earnestly advise every alcoholic to read this book
through, and though perhaps he came to scoff, he may re-
main to pray.
William D. Silkworth, M.D.
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